Clinical Study of Early Oral Feeding after Laparoscopic Radical Distal Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUWen-wen , TAORui-yu , YANKai-xu , HANXiao-peng , LIHong-tao ,  LIUHong-bin

Department of General Surgery, Lanzhou General Hospital of Lanzhou Military Area Command, Lanzhou 730050, Gansu Province, China;

Corresponding author：

LIUHong-bin, Email: liuhongbin999@163.com

Keywords：

Gastric cancer; Laparoscope; radical distal gastrectomy; Early oral feeding

DOI：

10.7507/1007-9424.20160343

Video：

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Objective To investigate safety and feasibility of early oral feeding after laparoscopic radical distal gastrectomy. Methods One hundred and fifty patients with gastric cancer admitted to hospital from May 2015 to Feb-ruary 2016 were divided into early oral feeding (EOF) group and traditional feeding (TF) group by a randomized contro-lled way. The relevant postoperative indicators, including postoperative complications (wound infection, inflammatory intestinal obstruction, anastomotic leakage, pulmonary infection, gastric retention), feeding tolerance (nausea, vomiting, and reinserting of gastric tube), nutritional status (serum albumin, prealbumin), immune function (IgA, IgG, IgM), recovery of gastrointestinal function (postoperative the first anal exhaust time and defecation time), hospitalization time, and hospitalization expenses, were observed and analyzed. Results ① One hundred and thirty-nine patients were included in this study, there were 72 cases in the EOF group, 67 cases in the TF group. The gender, age, boby mass index, etc. had no statistic significances between these two groups (P>0.05). ② All the patients of the two groups were cured and discharged, no patients died during perioperative period. The postoperative the first anal exhaust time, defecation time, and hospitalization time of the EOF group were significantly less than those of the TF group (P<0.05). The operative time, intraoperative blood loss, and postoperative hospitalization expenses had no significant differences between these two groups (P>0.05).③ The levels of serum albumin, prealbumin, and IgA on day 7 after operation in the EOF group were significantly higher than those in the TF group (P<0.05). The levels of IgG and IgM on day 7 after operation had no significant differences between these two groups (P>0.05). ④The tolerance rates of oral feeding of the EOF group and TF group patients was 91.7% (66/72) and 94.0% (63/67) respectively, the difference was not statistically significant (χ²=0.044, P=0.833). While 2 patients needed to be inserted gastric tube again due to nausea and abdominal distention in the EOF group, the symptoms were cured with conservative treatment about 3 d.⑤ The postoperative complications of the EOF group were 10 cases, TF group were 10 cases, the difference was not statistically significant (χ²=0.173, P=0.677). And postoperative complications were cured and discharged after active conservative treatment. Postoperative follow-up of 102 (102/139) cases were completed, follow-up time was 1-6 months, no patients admitted to hospital again for postopera-tive complications. Conclusion Early oral feeding after laparoscopic radical distal gastrectomy is safe and feasible, which don't only increase incidence of complications, but also improve nutritional status of patients, and promote recoveries of immune function and intestinal function, and shorten postoperative hospitalization time.

Citation： YUWen-wen, TAORui-yu, YANKai-xu, HANXiao-peng, LIHong-tao, LIUHong-bin. Clinical Study of Early Oral Feeding after Laparoscopic Radical Distal Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1339-1343. doi: 10.7507/1007-9424.20160343 Copy

1.	Gianotti L, Nespoli L, Torselli L, et al. Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program. Int J Colorectal Dis, 2011, 26(6):747-753.
2.	余震. 加速康复外科在胃癌手术中的应用. 中华消化外科杂志, 2015, 14(1):33-37.
3.	Chen ZX, Liu AH, Cen Y. Fast-track program vs traditional care in surgery for gastric cancer. World J Gastroenterol, 2014, 20(2):578-583.
4.	Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity:a randomized multicenter trial. Ann Surg, 2008, 247(5):721-729.
5.	周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用. 中国普外基础与临床杂志, 2010, 17(5):500-503.
6.	Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy:Enhanced Recovery After Surgery (ERAS) Society recommendations. Br J Surg, 2014, 101(10):1209-1229.
7.	蔡逊, 叶家欣, 马丹丹, 等. 完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究. 中国普外基础与临床杂志, 2016, 23(2):186-191.
8.	覃华波, 谢明颢, 练磊, 等. 直肠癌根治术:腹腔镜与开腹手术后并发症的比较. 中国普外基础与临床杂志, 2015, 22(5):530-534.
9.	Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparos-copic versus open D2 distal gastrectomy for advanced gastric cancer:A Randomized Controlled Trial. J Clin Oncol, 2016, 34(12):1350-1357.
10.	Goto H, Yasuda T, Oshikiri T, et al. Comparing the short-term outcomes of laparoscopic distal gastrectomy with D1⁺ and D2 lymph node dissection for gastric cancer. Asian J Endosc Surg, 2016, 9(2):116-121.
11.	Viñuela EF, Gonen M, Brennan MF, et al. Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012, 255(3):446-456.
12.	Zeng YK, Yang ZL, Peng JS, et al. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer:evidence from randomized and nonrandomized clinical trials. Ann Surg, 2012, 256(1):39-52.
13.	Ansari D, Gianotti L, Schröder J, et al. Fast-track surgery:procedure-specific aspects and future direction. Langenbecks Arch Surg, 2013, 398(1):29-37.
14.	熊玉琴, 肖清英, 游春凤. 经口进食在胃癌术后早期的应用. 实用临床医学, 2015, 16(10):86-87.
15.	马克强, 高春江, 汪志强, 等. 早期经口进食进行肠内营养在治疗急性重症胰腺炎中的作用. 重庆医学, 2015, 44(7):965-967.
16.	邱强, 曹家庆, 王琦, 等. 胃癌患者术后早期经口进食的安全性与可行性Meta分析. 中华胃肠外科杂志, 2013, 16(11):1045-1050.
17.	Li J, Ji Z, Yuan C, et al. Limited efficacy of early enteral nutrition in patients after total gastrectomy. J Invest Surg, 2011, 24(3):103-108.
18.	Tadano S, Terashima H, Fukuzawa J, et al. Early postoperative oral intake accelerates upper gastrointestinal anastomotic healing in the rat model. J Surg Res, 2011, 169(2):202-208.
19.	米磊, 仲蓓, 张佃良, 等. 胃癌患者术后早期肠内营养对临床结局的影响. 中华胃肠外科杂志, 2012, 15(5):464-467.
20.	冯立, 王峰, 董培德, 等. 胃癌患者根治术后早期肠内营养的临床疗效观察. 中国普外基础与临床杂志, 2014, 21(3):325-329.
21.	Boelens PG, Heesakkers FF, Luyer MD, et al. Reductionof postoperative ileus by early enteral nutrition in patientsundergoing major rectal surgery:Prospective, randomized, controlled trial. Ann Surg, 2014, 259(4):649-655.
22.	Guan X, Liu L, Lei X, et al. A comparative study of fast-track versus[corrected] conventional surgery in patients undergoing laparoscopic radical cystectomy and ileal conduit diversion:Chinese experience. Sci Rep, 2014, 4:6820.
23.	王祥安, 虞黎明, 范纪昌, 等. 加速康复外科应用于胃癌根治术对机体免疫功能影响Meta分析. 中国实用外科杂志, 2015, 35(10):1108-1112.
24.	Terashima M. The earlier the better? Gastric Cancer, 2014, 17(2):197-199.
25.	Adamina M, Gie O, Demartines N, et al. Contemporary periopera-tive care strategies. Br J Surg, 2013, 100(1):38-54.

1. Gianotti L, Nespoli L, Torselli L, et al. Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program. Int J Colorectal Dis, 2011, 26(6):747-753.
2. 余震. 加速康复外科在胃癌手术中的应用. 中华消化外科杂志, 2015, 14(1):33-37.
3. Chen ZX, Liu AH, Cen Y. Fast-track program vs traditional care in surgery for gastric cancer. World J Gastroenterol, 2014, 20(2):578-583.
4. Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity:a randomized multicenter trial. Ann Surg, 2008, 247(5):721-729.
5. 周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用. 中国普外基础与临床杂志, 2010, 17(5):500-503.
6. Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy:Enhanced Recovery After Surgery (ERAS) Society recommendations. Br J Surg, 2014, 101(10):1209-1229.
7. 蔡逊, 叶家欣, 马丹丹, 等. 完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究. 中国普外基础与临床杂志, 2016, 23(2):186-191.
8. 覃华波, 谢明颢, 练磊, 等. 直肠癌根治术:腹腔镜与开腹手术后并发症的比较. 中国普外基础与临床杂志, 2015, 22(5):530-534.
9. Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparos-copic versus open D2 distal gastrectomy for advanced gastric cancer:A Randomized Controlled Trial. J Clin Oncol, 2016, 34(12):1350-1357.
10. Goto H, Yasuda T, Oshikiri T, et al. Comparing the short-term outcomes of laparoscopic distal gastrectomy with D1⁺ and D2 lymph node dissection for gastric cancer. Asian J Endosc Surg, 2016, 9(2):116-121.
11. Viñuela EF, Gonen M, Brennan MF, et al. Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012, 255(3):446-456.
12. Zeng YK, Yang ZL, Peng JS, et al. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer:evidence from randomized and nonrandomized clinical trials. Ann Surg, 2012, 256(1):39-52.
13. Ansari D, Gianotti L, Schröder J, et al. Fast-track surgery:procedure-specific aspects and future direction. Langenbecks Arch Surg, 2013, 398(1):29-37.
14. 熊玉琴, 肖清英, 游春凤. 经口进食在胃癌术后早期的应用. 实用临床医学, 2015, 16(10):86-87.
15. 马克强, 高春江, 汪志强, 等. 早期经口进食进行肠内营养在治疗急性重症胰腺炎中的作用. 重庆医学, 2015, 44(7):965-967.
16. 邱强, 曹家庆, 王琦, 等. 胃癌患者术后早期经口进食的安全性与可行性Meta分析. 中华胃肠外科杂志, 2013, 16(11):1045-1050.
17. Li J, Ji Z, Yuan C, et al. Limited efficacy of early enteral nutrition in patients after total gastrectomy. J Invest Surg, 2011, 24(3):103-108.
18. Tadano S, Terashima H, Fukuzawa J, et al. Early postoperative oral intake accelerates upper gastrointestinal anastomotic healing in the rat model. J Surg Res, 2011, 169(2):202-208.
19. 米磊, 仲蓓, 张佃良, 等. 胃癌患者术后早期肠内营养对临床结局的影响. 中华胃肠外科杂志, 2012, 15(5):464-467.
20. 冯立, 王峰, 董培德, 等. 胃癌患者根治术后早期肠内营养的临床疗效观察. 中国普外基础与临床杂志, 2014, 21(3):325-329.
21. Boelens PG, Heesakkers FF, Luyer MD, et al. Reductionof postoperative ileus by early enteral nutrition in patientsundergoing major rectal surgery:Prospective, randomized, controlled trial. Ann Surg, 2014, 259(4):649-655.
22. Guan X, Liu L, Lei X, et al. A comparative study of fast-track versus[corrected] conventional surgery in patients undergoing laparoscopic radical cystectomy and ileal conduit diversion:Chinese experience. Sci Rep, 2014, 4:6820.
23. 王祥安, 虞黎明, 范纪昌, 等. 加速康复外科应用于胃癌根治术对机体免疫功能影响Meta分析. 中国实用外科杂志, 2015, 35(10):1108-1112.
24. Terashima M. The earlier the better? Gastric Cancer, 2014, 17(2):197-199.
25. Adamina M, Gie O, Demartines N, et al. Contemporary periopera-tive care strategies. Br J Surg, 2013, 100(1):38-54.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Early Oral Feeding after Laparoscopic Radical Distal Gastrectomy

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